The Effects of Market Competition on Cardiologists' Adoption of Transcatheter Aortic Valve Replacement.
The Effects of Market Competition on Cardiologists' Adoption of Transcatheter Aortic Valve Replacement.
复制标题
市场竞争对心脏病专家采用经导管主动脉瓣置换术的影响。
DOI：
10.1097/mlr.0000000000001391
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发表时间：
2020
期刊：
影响因子：
3
通讯作者：
Kanter,GenevieveP
中科院分区：
文献类型：
--
作者：
Groeneveld,PeterW;Yang,Lin;Segal,AndreaG;Karaca-Mandic,Pinar;Kanter,GenevieveP
背景：几十年来，关于高成本医疗技术的传播的普遍假设是，竞争性市场有利于医疗保健提供者更积极地采用新的治疗方法（即“医疗军备竞赛”）。然而，新的法规通过经导管主动脉瓣置换术（TAVR）可能会破坏这种范式时，TAVR introduced.Objective：本研究的目的是评估市场集中的医生组的做法和TAVR通过在其第一年的use.Research Design：这是一个回顾性队列研究Subjects：医生组的做法（n= 5116）提供介入心脏病学服务，在美国从2012年5月1日至2014年12月31日。协变量包括医生组的特征（即病例量、医院隶属关系、平均患者风险）以及县级和市场级特征。结果：截至2014年底，9.3%的实践采用了TAVR。考克斯比例风险模型显示风险比为1.26（95%置信区间：1.16-1.37，P< 0.001），医生组实践Herfindahl-Hirschman指数每增加1000点，表明组实践Herfindahl-Hirschman指数每增加1000点，TAVR采用率相对增加26%。集中市场的医生群体采用TAVR可能是管理TAVR报销的独特法规的结果，这有利于具有更大市场力量的医生群体采用TAVR。这些发现对未来的法规如何塑造技术采用模式具有重要意义。
Background:For decades, the prevailing assumption regarding the diffusion of high-cost medical technologies has been that competitive markets favor more aggressive adoption of new treatments by health care providers (ie, the “Medical Arms Race”). However, novel regulations governing the adoption of transcatheter aortic valve replacement (TAVR) may have disrupted this paradigm when TAVR was introduced.Objective:The objective of this study was to assess the relationship between the market concentration of physician group practices and the adoption of TAVR in its first years of use.Research Design:This was a retrospective cohort study.Subjects:Physician group practices (n= 5116) providing interventional cardiology services in the United States from May 1, 2012, to December 31, 2014.Measures:The first use of TAVR as indicated by a fee-for-service Medicare claim. Covariates including characteristics of the physician groups (ie, case volume, hospital affiliation, mean patient risk) as well as county-level and market-level characteristics.Results:By the close of 2014, 9.3% of practices had adopted TAVR. Cox proportional hazards models revealed a hazard ratio of 1.26 (95% confidence interval: 1.16–1.37, P< 0.001) per 1000 point increase in the physician group practice Herfindahl-Hirschman Index, indicating each 1000 point increase in group practice Herfindahl-Hirschman Index was associated with a 26% relative increase in the rate of TAVR adoption.Conclusions:Adoption of TAVR by physician groups in concentrated markets was potentially a consequence of the unique regulations governing TAVR reimbursement, which favored the adoption of TAVR by physician groups with greater market power. These findings have important implications for how future regulations may shape patterns of technology adoption.